Assignment: Obesity Evidence Based Research Brief and Systematic

Assignment: Obesity Evidence Based Research Brief and Systematic ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: Obesity Evidence Based Research Brief and Systematic Estimated length 1-2 pages; 50 points Include: Background/HistoryWhy was this systematic review completed? Why do we need this evidence analyzed.(5) Assignment: Obesity Evidence Based Research Brief and Systematic What was PICO question? (List as a question and define each component.Be sure to look at Powerpoint that discusses this; define your P,I,C and O) 8 points; 2 point each component Briefly discuss inclusion/exclusion criteria.What factors led to studies being excluded or included in this systematic review.(5) Methods: Methods of studies included in the review (5) Summarize results of research included in the systematic review.(5) Could PICO question be definitively answered?Why or why not? (5) Assess the evidence and if a grade is not provided give your opinions on grade using Academy’s EAL grading system? (5) How would this evidence contribute to your practice in working with this population? (5) Site Sources – AMA citation style preferred; individual studies pulled for brief should be cited (3) Grammar/editing- (5) Readability- Information conveyed in a clear and concise manner (5) PICO Question Example:Is supplemental Vitamin D effective in reducing depression in an adult population. P: adults I: Vitamin D supplements C: placebo O: decreased rates of depression ****Research Brief Format: ***** Name of Systematic Review Background/History PICO Question: Inclusion/Exclusion Criteria: Methods Results PICO Question Answered: P: I: C: O: Grade of Evidence: Use of this evidence for nutrition professionals: ( I have attached 2 articles but feel free to choose only one article.) panza_et_al_2018_obesity_reviews.pdf wu_et_al_2018_journal_ obesity reviews doi: 10.1111/obr.12743 Obesity Review/Public Health Weight bias among exercise and nutrition professionals: a systematic review G. A. Panza1,2 1 , L. E. Armstrong1, B. A. Taylor1,2, R. M. Puhl3,4, J. Livingston5 and L. S. Pescatello1 Department of Kinesiology, University of Connecticut, Storrs, CT, USA; 2 Department of Cardiology, Hartford Hospital, Hartford, CT, USA; 3 Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA; 4 Department of Human Development and Family Studies, University of Connecticut, Storrs, CT, USA; and 5 Department of Research Services, University of Connecticut, Storrs, CT, USA Received 9 May 2018; revised 20 June 2018; accepted 28 June 2018 Address for correspondence: GA Panza, Department of Kinesiology and Human Performance Laboratory, College of Agriculture, Health and Natural Resources, University of Connecticut, 2095 Hillside Rd, U-1110, Storrs, CT 06269-1110, USA. Summary Obesity affects approximately one-third of American adults. Recent evidence suggests that weight bias may be pervasive among both exercise and nutrition professionals working with adults who have obesity. However, the published literature on this topic is limited. This review aimed to (i) systematically review existing literature examining weight bias among exercise and nutrition professionals; (ii) discuss the implications of this evidence for exercise and nutrition professionals and their clients; (iii) address gaps and limitations of this literature; and (iv) identify future research directions. Of the 31 studies that met the criteria for this review, 20 examined weight bias among exercise professionals, of which 17 (85%) found evidence of weight bias among professionals practicing physical therapy (n = 4), physical education (n = 8) and personal/group fitness training (n = 5). Of 11 studies examining weight bias among nutrition professionals, eight (73%) found evidence of weight bias. These findings demonstrate fairly consistent evidence of weight bias among exercise and nutrition professionals. However, the majority of studies were cross-sectional (90%). Given that weight bias may compromise quality of care and potentially reinforce weight gain and associated negative health consequences in patients with obesity, it is imperative for future work to examine the causes and consequences of weight bias within exercise and nutrition professions using more rigorous study designs. E-mail: [email protected] Keywords: Exercise professionals, nutrition professionals, stigma, weight bias. Assignment: Obesity Evidence Based Research Brief and Systematic Abbreviations: BMI, body mass index; IAT, Implicit Associations Test; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Introduction More than one-third (36.5%) of adults have obesity in the USA (1). Individuals with higher body weight are vulnerable to experiencing stigma and discrimination because of their weight (2). While weight stigma can occur at diverse body weights, the highest rates (~45%) of weight discrimination are often reported among adults with class II to class III obesity (body mass index [BMI] ?35 kg m 2) (3,4). These stigmatizing experiences incur a range of negative consequences for emotional and physical health, including increased risk of depression (5,6), low self-esteem (7), poor body image (7), Obesity Reviews 19, 1492–1503, November 2018 psychological distress (8–10), continued obesity and weight gain (11), physiological reactivity (12,13), cardiovascular disease risk factors (14) and exercise avoidance (15). Of additional concern, substantial evidence has demonstrated that medical professionals including physicians, nurses, psychologists and medical students hold negative stereotypes and biases towards patients with obesity (2,16,17). As a result, patients with obesity may receive compromised care, be less likely to undergo health screenings and more likely to delay or avoid seeking healthcare (18,19). As research continues to document weight stigma in health care, emerging evidence has found weight bias to © 2018 World Obesity Federation obesity reviews be present among both exercise professionals (e.g. personal trainers and physical therapists) (20–22) and nutrition professionals (e.g. dietitians and nutritionists) (23). These are especially relevant professional populations to examine in the context of weight stigma, which if exhibited by exercise and nutrition professionals may affect the way their clients respond to exercise and nutrition programmes, and/or have adverse implications for their client’s mental and physical health. Specifically, there are demonstrated links between weight bias and unhealthy weight control, binge eating (24,25), increased overall food intake (26), weight gain (11,12) and difficulty maintaining weight loss (27), which make it difficult to adhere to or make progress with a nutrition regimen. Previous studies have also indicated that individuals with obesity who experience weight bias are less likely to participate in physical activity and physical education classes (28,29), have less desire to exercise, and decreased levels of moderate to vigorous intensity exercise (30). Thus, exercise and nutrition professionals who exhibit weight bias may create a harmful cycle in which they prescribe an exercise or nutrition programme that inadvertently reduces the likelihood of their clients’ participation or adherence and potentially reinforce behavioural patterns that contribute to weight gain and associated negative health consequences.Assignment: Obesity Evidence Based Research Brief and Systematic To gain a comprehensive understanding of the emerging literature in this important area of study, the current review aimed to (i) systematically review existing literature examining weight bias among exercise and nutrition professionals; (ii) discuss the implications of this evidence for exercise and nutrition professionals and their clients; (iii) address gaps and limitations of this literature; and (iv) identify future research directions. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards (31) were followed for the current review. Boolean searches were performed in PubMed, PsycINFO, CINAHL, Sociological Abstracts, ERIC, socINDEX, Academic Search Premier, Scopus and SportDiscus databases in consultation with a medical librarian for studies examining weight bias as an outcome among students or professionals in exercise or nutrition professions. Databases were searched from inception until 7 February 2018. Eligible exercise professions included any non-physician profession that may prescribe an exercise or physical activity regimen, such as physical therapists, physical education teachers, personal/group fitness trainers, exercise physiologists, exercise specialists and athletic trainers. Eligible nutrition professions included any nonphysician profession that may prescribe a nutrition regimen such as dietitians and nutritionists. Databases were searched using keywords related to bias (e.g. stigma, stereotyping, © 2018 World Obesity Federation Weight bias in exercise and nutrition G. A. Panza et al. 1493 discrimination and prejudice), body weight (e.g. overweight, obesity, fat and body mass index), exercise professionals (e.g. physical therapy, athletic trainers and personal trainers) and nutrition professionals (e.g. dietitian, dietetics and nutritionist). Exclusion of studies was based on the following a priori criteria (i) not published; (ii) not published in English; (iii) subjects aged <19 years; (iv) editorials, commentaries and/or other non-research articles; and (v) studies examining exercise or nutrition professionals as victims of weight bias. Only studies including weight bias as an outcome and examining the presence of bias expressed by exercise or nutrition professionals were included. Given that weight bias has been documented in many cultures around the world (32,33), studies outside of the USA were included if the study was published in English. A detailed search strategy is provided in Supplement 1. Results The search and selection process of studies included in this systematic review is presented in Fig. 1. A total of 31 studies that examined weight bias as an outcome among students or professionals in exercise or nutrition professions were included. A total of 29 studies were excluded after a full-text review for (i) not including the study population of interest (n = 13); (ii) not assessing the outcome of interest (n = 10); (iii) being published as a viewpoint review (n = 4); and (iv) being published in a foreign language (n = 2).Assignment: Obesity Evidence Based Research Brief and Systematic Detailed characteristics for all included studies are presented in Supplement 2, which are summarized according to the exercise or nutrition professional population studied. Five studies examined weight bias among exercise professionals in a clinical setting, including physical therapists (n = 4) (20,34–36) and physical therapist trainees (n = 1) (37). Eight studies examined weight bias among exercise professionals in an educational setting, including physical education teachers (n = 4) (22,38–40) and physical education teacher trainees (n = 4) (41–44). Seven studies examined weight bias among exercise professionals in an exercise setting including personal/group fitness trainers (n = 4) (21,45–47) and exercise professional trainees (n = 3) (48–50). Eleven studies examined weight bias among nutrition professionals including dietitians/nutritionists (n = 5) (51–55), dietetic/nutrition trainees (n = 5) (15,56– 59) and a mixed sample of nutrition professionals/trainees (n = 1) (60). Of the 31 included studies, one study measured only implicit weight bias (54), 21 studies measured only explicit weight bias (15,20,22,34–37,39,40,46,48,50–53,55–60) and nine studies measured both implicit and explicit weight bias (21,38,41–45,47,49). Implicit weight bias was assessed among the studies using the Implicit Associations Test (IAT) (61) (n = 10) (21,38,41–45,47,49,54). Effect sizes were calculated (62) and pooled for implicit weight bias results Obesity Reviews 19, 1492–1503, November 2018 1494 Weight bias in exercise and nutrition G. A. Panza et al. obesity reviews Figure 1 Flow chart detailing the systematic search of potential reports and selection process of included studies (n). [Colour figure can be viewed at wileyonlinelibrary.com] Obesity Reviews 19, 1492–1503, November 2018 © 2018 World Obesity Federation obesity reviews measured by the IAT, which included results from 10 studies (nine studies of exercise professionals and one study of nutrition professionals). The standardized mean effect size (d = 0.68, 95% CI = 0.46–0.89) was moderate (63) and favoured the presence of implicit weight bias across studies measuring implicit weight bias. Explicit weight bias was assessed among the studies using 14 different measures including the Fat Phobia Scale (64) (n = 7) (15,35,37,52,56– 58), Anti-Fat Attitudes Questionnaire (65) (n = 10) (22,34,38,41–45,49,50), Beliefs About Obese People Scale (66) (n = 3) (35,42,57), Attitudes Towards Obese People Scale (66) (n = 2) (42,60), Expectations of Overweight Youth (22) (n = 2) (22,42), Attitude Toward the Client Survey (67) (n = 1) (47), Behaviors Toward Obese and Averageweight Clients (68) (n = 1) (47), Sociocultural Attitudes Towards Appearance Questionnaire (69) (n = 1) (50), Toronto Empathy Questionnaire (70) (n = 1) (35), Youth Obesity and Physical Education Questionnaire (71) (n = 1) (22), case scenarios (n = 3) (39,40), developed questionnaire for the study (n = 7) (36,38,46,48,51,55,59), experimental assessment (n = 2) (15,47) and focus groups (n = 2) (20,53). In total, 11 studies (35%) examined gender differences in levels of weight bias among exercise (10 studies) (21,22,35,40,43,45,47–50) and nutrition (one study) (57) professionals. Six of these 11 studies found significant differences among men and women. Assignment: Obesity Evidence Based Research Brief and Systematic Findings were mixed, with men displaying higher levels of weight bias in two studies of fitness centre employees (45) and exercise science students (50) and women displaying higher levels of weight bias in one study among exercise science students (49). Additionally, compared with men, female physical therapists more commonly displayed empathy towards individuals with obesity in one study (35), and female physical education teachers were more likely to intervene in instances of weight bias towards students in another study (40). Finally, nine (21,35,37,39,49,54,57,59,60) of 31 studies accounted for the exercise or nutrition professional’s own body weight when examining their weight biases. Six (35,37,49,54,57,60) of these nine studies showed that the professional’s own body weight moderated their level of weight bias, such that exercise and nutrition professionals who were under or normal weight had higher levels of weight bias. Summarized in the following are the study findings for all study populations included in this review. Clinical exercise professionals Licensed physical therapists Two cross-sectional studies (35,36) examined weight bias among physical therapists. Wise and colleagues (35) enrolled 13 types of rehabilitation professionals (N = 221), with physical therapists being the most common clinical exercise-related profession (19%), and examined their attitudes and beliefs towards obesity using the Fat Phobia Scale © 2018 World Obesity Federation Weight bias in exercise and nutrition G. A. Panza et al. 1495 and the Modified Beliefs About Obese People Scale. Rehabilitation professionals, including physical therapists, demonstrated average levels (3.5 out of 5) of fat phobia, with higher levels of fat phobia found among younger (i.e. aged <40 years; p < 0.001) and normal weight professionals (i.e. BMI <25 kg m 2; p = 0.017). Beliefs about the cause of obesity was also a predictor of fat phobia (p < 0.001). In contrast, Sack and colleagues (36) found that 341 physical therapists who completed a paper mail survey designed to assess weight-related attitudes, knowledge and practice approaches demonstrated neutral attitudes towards individuals with obesity. The respondents’ knowledge scores (mean = 6.7 out of 10) and attitudes regarding statements about obesity were positively correlated (r = 0.133, p = 0.043), with higher scores indicating more positive attitudes. Setchell and colleagues (20) used an interpretive qualitative study design with Australian physical therapists (N = 27) to examine ways of talking about patients with overweight and obesity. The data were collected from six focus groups consisting of four to six physical therapists, who typically described patients with overweight/obesity as being minimally affected by stigma and difficult to treat. These physical therapists also described body weight as having simple causes and being important in physical therapy. The authors suggest that physical therapists should be further educated regarding the complex understandings of working with individuals with obesity as well as weight stigma. A cross-sectional study by Setchell and colleagues (34) reported similar findings among 265 Australian physical therapists. Participants in this study completed the AntiFat Attitudes Questionnaire and physical therapy case studies with patients of varying BMI. Weight stigma was assessed by comparing quantitative responses with the case studies among people with different BMI categories and by thematic and count analysis for free-text responses. Findings showed that physical therapists demonstrated a mean weight bias score of 3.2 (out of 8) on the Anti-Fat Attitudes Questionnaire.Assignment: Obesity Evidence Based Research Brief and Systematic Participant responses to the case studies were not indicative of weight bias for clinical parameters such as length of treatment time or amount of hands-on treatment with patients, but they did display explicit weight bias in free-text responses about patient management. Physical therapy trainees Awotidebe and colleagues (37) implemented a crosssectional, quantitative study design to examine knowledge and attitudes of 170 physical therapy students towards obesity. Although the students demonstrated average levels of knowledge regarding obesity on the Obesity Risk Knowledge Scale (mean score = 6 out of 10), more than 80% reported that obesity is a behavioural problem and 97.6% characterized individuals with obesity as lazy, unattractive, insecure and with lower self-esteem on the Fat Phobia Scale. Obesity Reviews 19, 1492–1503, November 2018 1496 Weight bias in exercise and nutrition G. A. Panza et al. Furthermore, the underweight or normal weight students were more likely to view individuals with obesity as having no endurance and self-indulgent. These findings highlight the importance of including weight bias as a topic of education within the physical therapy curriculum. Exercise professionals in education Physical education teachers Fontana and colleagues (38) conducted a cross-sectional stratified random sampling study design to examine implicit anti-fat bias (using the IAT) among physical education professors (N = 94) from randomly selected universities. The participants exhibited implicit ‘good-bad’ (p < 0.001) and ‘lazy-motivated’ (p < 0.001) anti-fat biases. Implicit antifat bias was also associated with disapproval of ‘obese’ physical education teachers as role models to students (p = 0.047). In addition, a majority (73%) of physical education teachers agreed that physical education teachers should not be obese (p < 0.001), because they are role models to their students, but 82% believed that physical education programmes should accept students with obesity (p < 0.001). The authors indicated that the anti-fat bias demonstrated by physical education professors may have a negative effect on the training of preservice physical education teachers working with students of diverse body types. Greenleaf and Weiller (22) examined anti-fat attitudes among physical education teachers (N = 105) and their performance and ability expectations for youth with and without high body weight. The physical education teachers reported moderate anti-fat attitudes (three out of five) on the Anti-Fat Attitudes Test and higher expectations for youth with healthy weight versus youth with overweight in skill areas of coordination (p < 0.05), strength (p < 0.05), sport competence (p < 0.001), physical ability (p < 0.001) and reasoning ability (p < 0.001). Peterson and colleagues (39) conducted a cross-sectional experimental study of physical education teachers and coaches (N = 162). The participants were randomly assigned to read a scenario about a male and female student of average weight or overweight who were the targets of weight-based victimization. The physical education teachers and coaches reported a higher likelihood of intervening when the female student victim was overweight rather than average weight, specifically in situations of relational victimization (i.e. behaviours detrimental to relationships or one’s social reputation; p = 0.019). Male teachers were less likely to respond to incidents of weight-based victimization compared with female teachers. The results of this study provide further evidence for the importance of increasing awareness of weight-based bias among physical educators and intervening to address weight bias regardless of a student’s gender. With this sample, Peterson and colleagues (40) additionally found that physical educators’ expectations and attitudes Obesity Reviews 19, 1492–1503, November 2018 obesity reviews regarding students may be negatively influenced by youths’ body weight and gender, with participants expressing poorer performance expectations in overweight women only. Physical education trainees Readdy and Wallhead (44) conducted an interpretive qualitative and quantitative study to examine implicit and explicit weight bias among 18 preservice physical education teachers a … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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